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President’s Advisory Committee on Student Mental Health (PAC-SMH) Community Partners Panel

FINAL REPORT Panel Co-Chairs: Tom Ruttan, PhD., C.Psych. Counselling Services (Co-Chair) Bonnie Taylor MSW, RSW AccessAbility Services (Co-Chair)

University of Waterloo PAC-SMH: Community Partners Panel Members: Tom Ruttan (Co-Chair of Community Panel; Director, Counselling Services, uWaterloo) Bonnie Taylor (Co-Chair; AccessAbility Services, uWaterloo) Alison Burnet (Director, Student Wellness, ); Sarah Chen (uWaterloo) Hsiao d’Ailly (Faculty, Renison University College) Lynn Ferguson (Grand River Hospital) Siddong Fu (Undergraduate Student, Psychology) Alison Kernoghan (School of Public Health & Health Systems, uWaterloo) Kimberly Kuntz (Institute of Quantum Computing, uWaterloo) Laura Libralto (Community Partner/Educator & Parent) Erm Lombardi (Parent) Tana Nash (Executive Director, Waterloo Region Suicide Prevention Council) Karen Ostrander (Director, Student Wellness Centre, Wilfrid Laurier University) Prabhjot Sangha (Undergraduate Student, AHS, Public Health) Rachel Thorburn (Undergraduate Student, Arts and Business, uWaterloo) Wanda Wagler-Martin (Executive Director, Shalom Counselling Services) Breana Walker (School of Accounting & Finance; Bereaved Families of )

Executive Summary

Panel members from a wide range of both on- and off-campus resources (e.g., uWaterloo, Renison University College, Wilfrid Laurier University, University of Guelph, parents, community agencies) met on numerous occasions throughout the Fall 2017 academic term to discuss mental health resources available to students.

These meetings resulted in clear and frank discussions of resources available, current working relationships between the University and off-campus mental health resources, gaps in services, strategies for enhancing the working relationships as well as resources, and recommendations the Panel believed were important for the benefit of student mental health. Discussions were augmented by presentations to/from community resources not directly represented on the Panel including crisis supports and community wrap around services.

The recommendations that flowed from the Panel’s meetings were separated into three main categories:

 Enhance Collaborative Partnerships  Develop and Implement Formalized Protocols  Improved Communication, Education & Training 2

The Panel also looked specifically at the available on- and off-campus resources as existing within a concept of “one community” and not within what was perceived by the Panel as a false dichotomy of on- and off-campus resources. It was believed that students access mental health resources both on and off campus and thus, the Panel viewed all resources as occurring within one larger community.

In addition, while the Panel remained entirely aware of the primary focus of the mandate being student mental health, the importance of addressing the mental health needs of the entire uWaterloo community (i.e., students, staff & faculty) was also strongly encouraged. Student mental health can only be aided and improved if the mental health of faculty and staff are a primary foci for uWaterloo as well.

It was also noted that there was a strong desire by the Panel for the working relationships amongst members to continue past the mandated end of the Panel, as the Panel has already began to open new doors into partnerships and mutual supports within the community agencies. Steps will be taken by the Panel to further enhance the collaboration among all members into the future.

Overview of Panel Mandate

The Panel’s mandate was to examine the relationship between the University and off-campus community agencies with regard to student mental health services. This relationship was examined through the Panel’s development of an expanded lens that valued both the mental health wellness of all uWaterloo members (i.e., students, staff & faculty) as well as the importance of viewing “community” not as an artificial dichotomy between on- campus and off- campus, but as one community which included mental health resources regardless of where they were accessed. Thus, the Panel chose to use the term, “community” to refer to mental health resources available for all members of uWaterloo regardless of where the resources may exist.

Members of the Panel were comprised of enthusiastic uWaterloo students, staff & faculty, off-campus agencies and organizations passionate about mental health. Additionally, the discussions benefitted significantly from the participation of members who were parents of university students. As a result, the input from all members of the Panel contributed very well to the examination of available mental health resources while providing a discerning perspective toward the development of important and respectful recommendations.

At the beginning of the Panel’s meetings, the relationship between uWaterloo and off-campus mental health resources varied from close (e.g., Grand River Hospital) to awareness (e.g., Canadian Mental Health Association) to non-existent (e.g., KW4 Connectivity). It was clear to the Panel early on that the knowledge of mental health resources as well as the working relationships between all organizations providing such resources needed to be stronger and clearer. This led to an early determined recommendation that the work examining the relationships amongst all mental health organizations needed to continue past the end of the mandate of the President’s Advisory Committee’s report.

Recognizing that the full community (including uWaterloo) had many resources available currently with both mental health as well as the social determinants of health, a great amount of time was spent by the Panel discussing the promotion and knowledge translation of these existing services. For example, how best could the Panel ensure these mental health services 3 and resources were known by staff, faculty and students? Additionally, the Panel also recognized the importance of consistency in messaging that mirrored existing messaging already used in the community such as the promotion of the HERE 24/7 line.

The Panel recognized the importance of language in the promotion of mental health, mental illness and suicide prevention services and resources. It was important to the members that altering the way mental health, mental illness and suicide were discussed created a safe space to have conversations that were helpful. Research has demonstrated that using strength-based positive messaging focusing on helpful behaviours was more beneficial to shifting change. The Panel noted the Federal government is currently creating a best practice language document for all federal departments. It was considered that uWaterloo could examine the Federal government’s initiatives in this area and potentially consider using some of the language from this document to benefit mental health resources on campus.

Additionally, the Panel recognized that uWaterloo is a very multi-cultural and diverse institution. In many cultures, there are no words to describe mental health, mental illness and suicide. Describing behaviours such as what stress looks like, healthy coping skills and self-care could be more beneficial for some individuals. Working in consultation with cultural groups in the development of effective promotion of messaging and resources was recommended.

Methodology The Panel met every three weeks with some additional meetings throughout the Fall 2017 academic term. Meetings were held at the with the option for members to participate via Skype.

As the membership of the Panel consisted of a wide range of parents, on-campus personnel as well as off-campus agencies, the fact finding and information gathering for the Panel was conducted through detailed and thorough discussions amongst the members. This expertise provided by the Panel represented both substantial breadth and depth of mental health resources available to students and thus, yielded significant knowledge existent resources as well as gaps in services.

A website content analysis was conducted on a number of relevant external web sites for the purpose of examining additional information and expertise to assist the Panel. Please see Appendix A for sites and resources examined.

In addition, representatives from the Panel attended a meeting of Connectivity KW4. This community meeting has members from more than 30 social service agencies, education and police who meet on a regular basis to discuss and problem solve the mental health needs of the KW region. The Panel’s representatives forged solid working relationships with the Connectivity group to better serve uWaterloo students and this relationship will continue past the end of the President’s Advisory Committee’s mandate.

As well, a member of the Canadian Mental Health Association’s (CMHA) Here 24/7 presented to the Panel to describe the resources available. This presentation led to increased working relationships between Here 24/7 and the Panel members. This relationship will also extend past the Committee’s mandate.

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Recommendations The Panel members examined a large number of relevant topic areas and arrived at several recommendations.

For ease of consideration, recommendations are presented below in subcategories of primary foci. These recommendations provide the Panel’s clear direction on actions, resources, and streamlined processes.

Enhance Collaborative Partnerships:

 Develop stronger relationships with community partners (i.e., within the full “community”) who serve the needs of student mental health and addictions. o Participate in existing community committees in the Region (e.g., Connectivity KW4); develop strategies for sharing information about workshops, seminars, resources available for individuals on- and off-campus for a mutual exchange of information regarding supports/services. o Invite and engage community partners to explore innovative ways to serve student mental health needs.

 Develop planning to enhance communication strategies for post-secondary institutions in the Region to build/improve relationships and exchange resources within the community. These institutions will communicate with community partners concerning stressful times of the school year and be aware of the ebbs and flows of an academic term.

 Prioritize the focus of mental health and addictions in the uWaterloo Strategic Plan, and that it reflects the Regional Plan for Mental Health. o include the off-campus community agencies as additional supports for the students living in the community with specific declarations as to how the University can work with these agencies.

 Develop planning with off-campus housing resources (e.g., Domus) to assist in communication of available mental health resources for students.

Develop and Implement Formalized Protocols:

By developing clear protocols and guidelines, students, faculty and staff have clear direction in processes becoming more streamlined and efficient. Additionally, the implementation of protocols will enhance their sustainability into the future.

 Develop and support a system within the University that connects individual mental health resources and facilitates collaboration and communication to aid uWaterloo members struggling with mental health issues.

 Develop a seamless protocol to connect students from an on-campus wellness service to an off-campus service o e.g., at uWaterloo, have one of the Counselling Services’ Intake Specialists connect via phone directly with an off-campus service provider with the student present, to arrange ongoing or additional supports.

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 Determine how uWaterloo can support students not in school (e.g., when they are removed from registration, banned from campus, on sick leave, required to withdraw, etc.). o e.g., any documentation sent to a student regarding situations such as noted above needs to incorporate the supports and resources available to them on- and off-campus.

 Develop a protocol to include community partners when communicating adverse events which involve a member of the University community. This will provide a greater and more inclusive community response and a wide variety of resources can be made available to those uWaterloo members impacted by the event.

 Collect data on suicide deaths in partnership with the Region's Public Health department. Across the province, there is a call to action for improved data collection in this area. The largest gap in suicide mortality rates identified by epidemiologists is in post-secondary populations. Research has found that internally collected mortality data is sufficient for driving quality improvement in the prevention of suicide. Pursuing the larger goal of improving data collection in all post-secondary schools in the Region would aid efforts of identifying trends to guide preventative work.

Improved Communication Education and Training:

 Clearly describe all mental health resources in the Region available to post-secondary students to facilitate access by anyone wishing to obtain more information and/or to become directly involved with the resource(s). This information will be highly visible with an easily identifiable icon where anyone can access mental health information. This icon will be available in a wide variety of locations (e.g., in student residence rooms both off- and on-campus, recreational facilities/restaurants/bars frequented by students, etc.).

o All off-campus student housing locations to post resources describing support in every bathroom and other key locations (e.g., fridge magnets etc.). Resources will be developed in key different languages.

 Ensure awareness for every student, staff and faculty member to be able to directly access community crisis supports including the new Canadian Suicide Crisis Hotline (released in November 2017).

 Ensure awareness for every student, staff and faculty member of all mental health walk-in services available in the Region both off and on campus.

 Provide each student with information regarding the funding they can access in order to receive mental health services off-campus. o Information will be provided to off-campus community resources so they can assist the student in determining available funding to cover costs of the service (i.e. FEDS/GSA Health & Dental Plan; Bursary for Students with Disabilities (BSWD) if OSAP eligible). o Campus Wellness informs students about funding options when exploring options of accessing off-campus mental health services. 6

o Students to be informed that they can access funding for off-campus mental health services without requiring documentation from a practicing physician.

 Ensure that every student can easily access information on financial literacy including offering budgeting workshops to reduce the impact of financial strain on students’ mental health.

 Develop more direct and clear partnerships between Campus Wellness and the uWaterloo Co-Op program to provide access and promote availability of community resources while students are on co-op placement. o The Campus Wellness website to clearly describe how a student in a locale away from the University can access mental health resources both in Canada and abroad including crisis resources.

 That the University dedicates funding yearly for research projects examining how best to facilitate enhanced mental health resources both off- and on-campus student (e.g., University of Calgary grants (http://ucalgary.ca/mentalhealth/cmhs-grants). o By allocating funds to this type of grant process, the University would be investing in and supporting the campus community in developing innovative ways to address mental health and wellness on campus in a collaborative design to include off-campus mental health resources. o This will serve to encourage wider community involvement (e.g., grants might be available up to a larger amount if the application is co-developed with community members, agencies, etc.).

 Information regarding student mental health resources (e.g., a link to a brief video) to be sent with every student’s acceptance letter, required to withdraw documentation, ban letter, leaving on medical leave, etc.

 Provide information for parents regarding mental health resources available for their children in the Region both on and off-campus (e.g., link to brief video).

 In collaboration with other University student services, arrange an annual information event for first year students & parents involving all Regional college/universities be hosted at uWaterloo in conjunction with community partners with the focus on student mental health wellness. o e.g., the foci can include: what to expect during first year, on- and off-campus mental health resources available and how to access them, how parents can set their children up for success. This event will live streamed as well as recorded to be made available later for viewing by students & parents who cannot attend.

 Review student mental health strategies at other post-secondary institutions in North America and the United Kingdom with the focus on the enhancement of collaborative working relationships and agreements with community mental health resources.

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Future Considerations When establishing relevant foci, one of the Panel’s intentions was to craft recommendations for how off campus students could access community resources and supports. This included students attending all campus locations of UWaterloo as well as their Co-Op placements and International Exchange programs. Students will need to have access to mental health and wellness supports regardless of location and further exploration regarding specific recommendations to facilitate this process should be considered. In addition, the Panel believed strongly that the members needed to continue to meet beyond the mandate of the President’s Advisory Committee on Student Mental Health. The benefits for both on- and off-campus mental health resources and especially the advantages for our uWaterloo students will continue to grow and expand with such continued working relationships. University support for such a continuation of collaborative affiliations would provide significant benefit for everyone involved with student mental health.

As well, the Panel encouraged uWaterloo representatives (e.g., AccessAbility Services, Counselling Services) to maintain close collaborative working relationships with other community agencies such as Connectivity KW4 and Here 24/7 for the benefit of students who become involved with those agencies.

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Appendix A

Connectivity KW4: Sue Coulter, Community Navigator

Website description of Connectivity KW4: “Provides immediate coordinated and integrated responses, through mobilization of resources to address situations facing individuals, families or communities with acute elevated risk factors. Any organization can bring or refer a situation to Connectivity. Situations brought to the meetings, by an organization, are those that involve a level of significant risk to an individual, the community, or both. Previous attempts to provide service have not been effective. Situations that could be more effectively managed in a multi- organization manner. See Appendix B for details of membership. http://www.carizon.ca/community-services/connectivity-kitchener/

Community outreach: Nov 2/17- Tom Ruttan and Bonnie Taylor attended the Connectivity KW4 table to represent the Panel, bring attention to the PAC-SMH work and to enquire about possible partnerships and collaborative processes which would include UWaterloo and the community, for the purpose of better supporting the UWaterloo students mental health.

Here 24/7: Website description: “Here 24/7 is your front door to the addictions, mental health and crisis services provided by 12 agencies across Waterloo Wellington. All you need to do is reach out to us. We do the intake, assessment, referral, crisis, waitlist and appointment booking work for these important programs. It’s our job to be your guide, figure out your needs and help you navigate the system. This leaves you free to focus on maintaining hope and pursuing recovery.” http://here247.ca/

 Sheila Roewade Team Lead, Here 24/7 attended the Panel meeting on Nov 30/17

Additional mental health supports discussed:

The Big White Wall: peer/counselling therapeutic platform online through CMHA- avail free to everyone. Must be computer literate, anonymous tag/label for name is provided after registration, take quizzes to identify concerns i.e. anxiety, depression. Intended for lower tertiary levels of mental health https://www.bigwhitewall.com/v2/landingUK.aspx?ReturnUrl=%2f

Crisis Services Canada: Intended for crisis support only This service is available across Canada via toll-free phone, chat or text in English and French. This means anyone in Canada that is thinking about, is or has been affected by suicide, can reach out across a variety of media, and feel supported 24 hours a day, 7 days a week. http://www.crisisservicescanada.ca/en/

The Centre for Innovation on Campus Mental Health (CICMH) A partnership project involving Colleges Ontario, the Council of Ontario Universities, the Ontario Undergraduate Student Alliance, the College Student Alliance and the Canadian Mental Health Association, Ontario Division. http://campusmentalhealth.ca/

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Campus-Community Connection Toolkit: http://toolkit.campusmentalhealth.ca/ Developed to help Ontario’s post-secondary service providers support students with complex mental health and/or addiction concerns through coordinated care on-campus and off-campus.

Pamphlets to discuss feelings after suicide attempt or suicide completion: e.g., Suicide Prevention Council have an online pamphlet and resources http://wrspc.ca/wp-content/uploads/2017/09/griefafterasuicide.pdf

Make mental health part of every aspect of UWaterloo: https://healthycampuses.ca/wp-content/uploads/2014/09/The-National-Guide.pdf

Awareness Campaigns:

In It Together: Taking Action on Student Mental Health, Report published November 2, 2017 Recognizing that Ontario must be proactive in addressing current challenges and responding to future challenges, the College Student Alliance, the Ontario Undergraduate Student Alliance, Colleges Ontario and the Council of Ontario Universities have come together to develop an action plan on post-secondary student mental health. http://cou.on.ca/reports/in-it-together/

Stick to Life Program: “Stick to Life” is a sticker campaign addressing male depression and suicide on Prince Edward Island. It was developed by the Prince Edward Island Suicide Prevention Committee; a committee of the Canadian Mental Health Association/PEI Division. This committee is dedicated to reducing the suicide rate and lessening the impact of completed suicide on PEI. http://pei.cmha.ca/programs-and-services/stick-to-life-program/

The Okanagan Charter: A review of this document may be helpful for the Panel to be familiar with regarding overall student health and recommendations http://internationalhealthycampuses2015.sites.olt.ubc.ca/files/2016/01/Okanagan-Charter- January13v2.pdf

Campus Mental Health Strategy Grants- University of Calgary: e.g., offer grants to foster improvements in student mental health (http://ucalgary.ca/mentalhealth/cmhs-grants). “The Campus Mental Health Strategy Grants were created to get our community thinking about how they can foster positive mental health and wellness, and help build a supportive environment, through their own big ideas. Do you have an idea that you think would make our campus a more caring and supportive place? Apply today for a grant of up to $10,000. “

Prioritizing and supporting cross-faculty research in mental health: e.g., Network for Aging Research at the University of Waterloo (https://uwaterloo.ca/network-for- aging-research/about/our-history )

Sample of campus mental health strategy: University of Calgary: http://ucalgary.ca/mentalhealth/

Mental Health focused workshops: The Inquiring Minds: The Inquiring Mind, geared towards an undergraduate student audience, aims to increase awareness of mental health, reduce the stigma of mental illnesses and offer resources to maintain positive mental health and increase resiliency. Equally important goals 10 are to create a supportive environment, strengthen the campus culture, and contribute to a healthy campus. https://www.ucalgary.ca/wellnesscentre/events-programs/training/inquiring-mind

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Appendix B Connectivity KW4 - Sue Coulter Connectivity Navigator Connectivity KW4 is comprised of 31 partner agencies. Connectivity KW4 brings health and social service agencies to a weekly meeting, to collaboratively and proactively address situations of elevated risk and support individuals to access the services they need. In doing so, organizations and systems are immediately responsive and begin to make systematic improvements to improve service delivery, with the long term vision of reducing emergency room admissions, child protection cases, prosecutions, violent crime and youth victimization. http://www.carizon.ca/wp-content/uploads/2015/04/Connectivity-Eighteen-Month-Report.pdf

Connectivity KW4 Partner Agencies (as of 2016)  Canadian Mental Health Association Waterloo Wellington Dufferin  Carizon Family and Community Services  Community Care Access Centre/Elder Abuse Response Team  Developmental Services Resource Centre - Waterloo Region  Family and Children’s Services of the Waterloo Region  The Family Violence Project of Waterloo Region  Front Door  Grand River Hospital  The Hoarding Project (Supportive Housing of Waterloo)  House of Friendship  Interfaith Community Counselling Centre  Kitchener-Waterloo, Wilmot, Woolwich and Wellesley Community Ward/Health Link  Lutherwood  Ministry of Children and Youth Services  Ministry of Community Safety and Correctional Services  oneROOF Youth Services  Promise of Partnership (Carizon Family and Community Services)  Ray of Hope  Region of Waterloo Community Services Employment and Income Support  Sexual Assault Support Centre of Waterloo Region  St. John’s Kitchen (The Working Centre)  Stonehenge Therapeutic Community  Victim Services Waterloo Region  Waterloo Catholic District School Board  Waterloo Region District School Board  Waterloo Regional Police Service  Waterloo Region Sexual Assault Domestic Violence Treatment Centre  White Owl Native Ancestry Association  Wilmot Family Resource Centre  Youth Addiction Services (Ray of Hope)  YWCA Kitchener Waterloo YWCA 12

Connectivity KW4 Secondary Agencies- These agencies do not to sit at the table on a weekly basis, but have been important partners by referring situations and/or assisting with situations.

 Elizabeth Fry Society Southern Ontario Region  Hospice of Waterloo Region  Lutherwood – Housing Services  Ontario Disability Support Program  Saugeen Health Centre  Service Resolution Coordination  St. Mary’s Counselling Service  Women’s Crisis Services Waterloo Region  Woolwich Community Health Centre